Physical Therapy Tips for People with Normal Pressure Hydrocephalus - Hydrocephalus Canada (2022)

  • February 12, 2019
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  • February 12, 2019
(Video) Normal Pressure Hydrocephalus \\ everything you need to know

Physical Therapy Tips for People with Normal Pressure Hydrocephalus

By Trish Bogucki

Guest Blogger for the Adult Hydrocephalus Clinical Research Network

By the time I was diagnosed with NPH and had shunt surgery, I had lost my ability to walk unaided, so I was very eager to begin Physical Therapy. I was thrilled when my neurosurgeon cleared me for driving a few weeks after surgery and gave me a prescription for physical therapy; my first drive was to their office.

My neurosurgeon told me that PT for NPH patients should focus primarily on improving balance and gait. Some amount of strength exercises may be good as well, but NPH patients should insist on at least equal time spent on gait and balance.

Tip #1: Talk to your physical therapist about incorporating balance exercises if your PT routine does not include them

My therapist did an initial evaluation and created an exercise program for me that included a variety of balance and strength exercises as well as walking on a special treadmill to improve my gait. The cameras on the AlterG treadmill showed me how irregular my gait was and over time it helped me reprogram my walking. As my gait improved I spent less time on the strength exercises and much more time on balance.

Tip #2: Set short term and long term goals for your physical therapy

My first goal was independent walking – no cane and no one to hang onto. My long term goal was to get back to the Advanced Step Class at the gym that I loved so much before NPH sidelined me. I wasn’t sure I’d ever reach that goal since my walking was so poor, but I still went to the gym several times a week and used the elliptical and bike to warm up before therapy. I occasionally watched the Step Class and told myself over and over that I would be back.

Tip #3: Learn to love your PT sessions and spend as long as you need to get through all your exercises

I came to regard PT as going to the gym with friends who picked up all my equipment for me. I usually spent around two hours at each session three times a week – 30 to 40 minutes on the AlterG followed by a series of balance and strength exercises The AlterG is a magical combination of a regular treadmill with an air chamber that relieves your feet and legs of up to 75% of your weight. You put on special shorts with a zippered flange across the top so you can be zippered into the chamber which is then inflated with air. The AlterG was the single most important component of my physical therapy – it allowed me to walk without fear of falling and gradually my gait lengthened and strengthened. There are cameras on each side and in the front so you get instant feedback on a video screen on your walking and you can make adjustments immediately. It took me a long time to see permanent and significant improvement, but I was encouraged by the small improvements I saw temporarily after each session.

(Video) Life with Normal Pressure Hydrocephalus

Tip #4: Be proactive to prevent boredom – don’t let your PT sessions become cookie cutter

Ask your therapist to remind you how an exercise should be done and try to find things to laugh at. I dubbed one of my exercises “Walk the Dog” where I played the part of the dog. In this exercise I was tethered to a weight on a pulley and had to work hard to walk away from the pulley while dragging the weight and then not fly backwards when I returned to starting position. This routine took up a lot of space in the middle of the main room, and patients and their aides were naturally amused to see this rather large “dog” pulling on her harness, so occasionally I would “Woof!” just to get a smile.

My therapist created another exercise that had me jogging around cones while an aide tossed a squishy ball at me from various angles. It challenged my balance greatly but the squishy ball couldn’t do any damage if I missed it (and I missed a lot at first). I still use this exercise a year later to further strengthen my balance and reflexes.

Tip #5: As your walking improves, focus attention at PT on the activities that give you the most trouble

After some months of therapy I finally started seeing lasting improvement in my gait but noticed that I still had issues on sloping surfaces, including navigating slanted flooring in the corridors at work and any grassy terrain. I asked my neurosurgeon about it and he said that the brain can have trouble with slopes especially downhill. He suggested we find a way to work on that with the AlterG.

The Alter G does not have a decline setting but it does incline and it can run in reverse. So my therapist, an aide and I got together and figured out that I could face backwards and they would run the treadmill in reverse on an incline. Of course I had to put the shorts on backwards too but we were not worried about fashion. And the best part of all this creativity? I saw improvement after just one session of practicing my downhill walking!

(Video) Normal Pressure Hydrocephalus: a neurologist's perspective

Tip #6: Prepare for life after PT

Once you have achieved your short term goals and you’re not seeing improvements after every session it may be time to talk with your therapist about ending therapy. Of course some insurance plans are not as generous as mine was so you may not have the luxury of choosing when to end therapy.

I asked my therapist when I should end therapy, and he asked me if I was able to do all my exercises comfortably and he wanted approval from the prescribing doctor. I also tried going back to Step Class and found to my great delight that I could manage most of it, so I had achieved both my short- and long-term goals.

Tip #7: Don’t stop cold turkey

Once we agreed it might be time to end therapy, my therapist put me on a reduced schedule: two times a week (instead of 3) for two weeks then once a week for two weeks, and all was well, so I was done! It was bittersweet really – after a year and five months of therapy three times a week PT had become a big part of my life. My therapist gave me exercises to do on my own and then set me free. I immediately increased my trips to the gym and hired a personal trainer to keep me challenged.

I asked my therapist when I should end therapy, and he asked me if I was able to do all my exercises comfortably and he wanted approval from the prescribing doctor. I also tried going back to Step Class and found to my great delight that I could manage most of it, so I had achieved both my short- and long-term goals.

Post Script: A few months before my therapy ended there was a video shoot at my therapy center on the benefits of using the AlterG and I was invited to participate. Normally I avoid cameras, but this was different: the AlterG and the PT center had done me so much good that I wanted to spread the word. The video clip is now posted on the AlterG section of my therapy center’s website; if you’re interested you can see it in the box labeled Neurological AlterG on this page.

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FAQs

Can physical therapy help hydrocephalus? ›

Physiotherapy treatment for Hydrocephalus

Hydrocephalus can affect balance, co-ordination, mobility and walking ability. Physiotherapy is needed to help aid your child's development and improve their function.

Is walking good for hydrocephalus? ›

Slow, gentle exercises such as tai chi, chair yoga, and water exercise are less likely to cause falls and injuries. Exercise bikes and elliptical machines are also good options, as are activities that allow you to grab bars or handles to reduce the risk of falling. Walking is also a good activity, even with a walker.

How do you manage normal pressure hydrocephalus? ›

How is normal pressure hydrocephalus treated? A commonly used treatment for NPH is surgery to place a tube, called a shunt, into the brain to drain the excess fluid. The shunt is usually inserted into a ventricle in the brain and then passed under your skin from your head through your neck and chest to your abdomen.

What are the long term effects of normal pressure hydrocephalus? ›

The symptoms of NPH usually get worse over time if the condition is left untreated. Patients with untreated, advanced NPH may experience seizures, which can get progressively worse. Dementia and/or bladder control problems usually appear after gait disturbances as the condition progresses.

What can people with hydrocephalus not do? ›

However, people with LP shunts should avoid any activity which involves twisting at the waist, as this can dislodge the shunt.
  • Martial arts. Any activity that involves being grabbed around the neck is not advised, as the shunt tubing in the neck can crack. ...
  • Rugby. ...
  • Gymnastics and dance. ...
  • Water sports. ...
  • Golf. ...
  • Other activities.

How long does it take to recover from normal pressure hydrocephalus? ›

Studies show that 50 to 80% of patients can expect improvement of their symptoms in the first 2 to 3 years [1]. Other patients may have a less successful outcome. Several factors determine the outcome, including the patient's overall health, what caused the NPH to occur, and how long the patient has had NPH.

Can you fly with normal pressure hydrocephalus? ›

A statement from the Hydrocephalus Association Medical Advisory Board: The air pressure in an airplane cabin is approximately the same if you were at 7,000-8,000 feet of altitude which should not pose a problem.

Does hydrocephalus affect memory? ›

The major cognitive impairment in patients with idiopathic normal pressure hydrocephalus (iNPH) is frontal lobe symptoms, such as psychomotor slowing and impairment of attention, working memory, verbal fluency and executive function.

Does hydrocephalus make you pee a lot? ›

The change in the way you walk is often followed by bouts of urinary incontinence, which may include symptoms such as: a frequent need to pee.

How does NPH affect walking? ›

Difficulty walking.

In many cases, people with NPH have trouble picking up their feet. Some describe it as feeling like their feet are stuck to the floor. This can lead to a shuffling walk and problems going up stairs and over curbs. It also increases your risk of falling.

How long can adults live with normal pressure hydrocephalus? ›

Conclusions: Clinical improvement of patients with NPH can be sustained for 5-7 years in some patients with NPH, even if shunt revision surgery is needed multiple times.

Does NPH cause fatigue? ›

As symptoms appear gradually and may be associated with old age, many people think they are normal or assume they must learn to live with them. You may find that you become much more tired than you would expect.

Does NPH run in families? ›

Normal pressure hydrocephalus (say: hi-drosef-uh-lus; or NPH for short) is a rare, but sometimes treatable, cause of dementia. It mainly affects people older than 60. It does not run in families. Sometimes it happens after a brain infection, such as meningitis.

What does NPH gait look like? ›

Specific features of the gait disturbance in normal pressure hydrocephalus were a broad based gait pattern with outward rotated feet and a diminished height of the steps. After treatment in both diseases, the speed increased, due to an enlarged stride length, now presenting a lower variability.

Is NPH a progressive? ›

Normal Pressure Hydrocephalus (NPH) is a cause of progressive dementia that includes three primary symptoms: (1) progressive cognitive impairment, (2) gait and balance difficulties, and (3) urinary frequency and/or incontinence.

How does hydrocephalus affect a person physically? ›

Among adults 60 years of age and older, the more common signs and symptoms of hydrocephalus are: Loss of bladder control or a frequent urge to urinate. Memory loss. Progressive loss of other thinking or reasoning skills.

How does hydrocephalus affect a person emotionally? ›

Normal Pressure Hydrocephalus and Depression

Symptoms include irritability, fatigue, withdrawal, sadness, and an inability to eat or sleep. Brain imaging studies have shown that depression can be associated with right dominant brain dysfunction.

Is hydrocephalus a disability? ›

You cannot get disability automatically for hydrocephalus because it is not a specifically listed condition in Social Security's "blue book" of listed impairments.

Is NPH a form of dementia? ›

Normal pressure hydrocephalus (NPH) is a rare but potentially treatable form of dementia. Shunting will improve functioning in 40% to 50% of patients. 2. The classic symptoms of NPH are dementia characterized by mild memory impairment and apathy, ataxic gait, and urinary hesitancy or incontinence.

How long does a shunt for NPH last? ›

There are two types of shunts: non-programmable and programmable. The programmable type has valves that allow the shunt to be adjusted with a magnetic device after surgery to increase or decrease the drainage rate of the shunt. The shunt used for treating NPH usually remains in the brain permanently.

Does NPH affect vision? ›

Hydrocephalus can affect vision in two different ways: 1) Damage to Optic Nerve, 2) Damage to Nerves that Control the Eye Muscles. Visual information is transmitted to the brain by the optic nerve, a bundle of fibers that run from the eye to the brain.

Can you go through a metal detector with a shunt? ›

mHealth Tools & Accommodations for Living with Hydrocephalus

I recommend that if you have any type of programmable CNS shunt, that you do not go thru metal detectors.

Why does NPH cause incontinence? ›

The bladder disorders in NPH are the result of a hyperactive detrusor muscle due to reduced or absent central inhibition. At first the patient suffers from an increased micturition frequency. In the further course, urge incontinence usually follows and can progress to an absolute urinary incontinence.

Does NPH cause headaches? ›

Early Symptoms of NPH and Diagnosis

Headaches, nausea, and difficulty concentrating may also occur due to the swelling of the brain. NPH is a progressive condition, with symptoms that worsen over time.

How common is normal pressure hydrocephalus? ›

The Hydrocephalus Association estimates that nearly 700,000 adults have normal pressure hydrocephalus, but it is often misdiagnosed as Alzheimer's or Parkinson's disease. In fact, less than 20 percent of people with the disease are properly diagnosed.

Can hydrocephalus cause anger issues? ›

Without knowing why, a child or young person with hydrocephalus could become really upset or angry with someone. It's not always about the other person. It can be about feeling lost when they can't work out what is going on or how to make it better.

Can you live a normal life with hydrocephalus? ›

What is the prognosis? If left untreated, hydrocephalus can be fatal. Early diagnosis and successful treatment improve the chance for a good recovery. With the benefits of surgery, rehabilitative therapies, and educational interventions, many people with hydrocephalus live relatively normal lives.

Does NPH affect balance? ›

The cause of balance disturbances being a frequent symptom in NPH is an abnormal cerebellum control over various groups of muscles and over correct flow of neural stimuli to these muscles.

What are 4 types of hydrocephalus? ›

The four main types of hydrocephalus are communicating hydrocephalus, non-communicating hydrocephalus, normal pressure hydrocephalus and hydrocephalus ex-vacuo. Communicating hydrocephalus occurs when the flow of CSF is blocked after it leaves your ventricles.

What happens if too much CSF is drained? ›

It is possible that the puncture of the ventricle or the opening of the dura will result in an intracranial hemorrhage. It is possible that if too much CSF is removed from the ventricles, either during a drainage procedure or when the ventricle is first punctured, the ventricle may collapse and occlude the catheter.

Is NPH reversible? ›

NPH is a potentially reversible syndrome characterized clinically by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia and urinary incontinence.

Can Covid cause NPH? ›

Possible mechanisms for NPH after COVID include disruption of choroid plexus cells by direct viral invasion or as a result of neuroinflammation and cytokine release and hypercoagulability leading to venous congestion and abnormalities of CSF flow.

What foods help with hydrocephalus? ›

Mediterranean diet
  • high consumption of extra virgin olive oil rather than other fats.
  • high intake of fish.
  • high intake of fruit, vegetables, cereals and legumes.
  • moderate intake of alcohol (usually red wine)
  • low intake of meat (in particular, red meat)
  • low to moderate intake of dairy products.

How old is the oldest person with hydrocephalus? ›

The longest living hydrocephalic is Theresa Alvina Schaan (Canada) who was born on the 17 March 1941 and diagnosed with having congenital hydrocephalus. Also known as "water on the brain," it is a condition in which there is extra cerebrospinal fluid (CSF) around the brain and spinal cord.

Can you recover from NPH? ›

The symptoms of NPH usually get worse over time if the condition is not treated, although some people may experience temporary improvements. While the success of treatment with shunts varies from person to person, some people recover almost completely after treatment and have a good quality of life.

Does NPH cause leg weakness? ›

Older patients with NPH appear not to have involuntary movements, tremors, tingling or pain in the hands and feet, or numbness associated with Parkinson's disease or other neurological conditions. However, a feeling of weakness in the arms and legs and stiffness in gait is not uncommon for patients with NPH.

Does weather affect hydrocephalus? ›

Hydrocephalus patients complain about symptoms related to weather changes, especially changes in atmospheric pressure (pat).

Can hydrocephalus affect mobility? ›

Normal pressure hydrocephalus (NPH)

Mobility problems, dementia and urinary incontinence are the main symptoms of NPH.

How often should a brain shunt be checked? ›

All younger patients with a shunt should probably be encouraged to seek a neurosurgical check up at least every three years, ideally at a dedicated hydrocephalus follow up clinic.

Can NPH cause dizziness? ›

NPH is associated with a classic triad of dementia, gait disturbance, and urinary incontinence. We report on a patient with NPH presenting with repeated vertigo, headache and nausea. A 21-year-old woman complained of rotatory vertigo, pulsatile headache, nausea and tinnitus in both ears.

How long does a shunt last in adults? ›

The average lifespan of an infant's shunt is two years. Adults and children over the age of 2 may not need a shunt replacement for eight or more years. Shunt systems require frequent monitoring and follow-up.

What is a Festinating gait pattern? ›

Festinating gait is described as rapid small steps done in an attempt to keep the centre of gravity in between the feet while the trunk is leaning forward involuntarily.

Does normal pressure hydrocephalus affect speech? ›

Preoperatively, 86% of patients with NPH had swallowing problems and 75% had speech deficits due to velopharyngeal inadequacy.

What is gait disturbance in normal pressure hydrocephalus? ›

Specific features of the gait disturbance in normal pressure hydrocephalus were a broad based gait pattern with outward rotated feet and a diminished height of the steps. After treatment in both diseases, the speed increased, due to an enlarged stride length, now presenting a lower variability.

Does hydrocephalus worsen with age? ›

The symptoms of NPH usually get worse over time if the condition is left untreated. Patients with untreated, advanced NPH may experience seizures, which can get progressively worse. Dementia and/or bladder control problems usually appear after gait disturbances as the condition progresses.

What are the physical effects of hydrocephalus on mobility? ›

In adults, symptoms of hydrocephalus can include: Difficulty with walking including inability to begin walking (gait apraxia) Weakness of the legs. Problems with balance.

What should you avoid with a VP shunt? ›

Do not touch the valve on your head. It is okay for you to lie on the side of your head with the shunt. For 6 weeks, do not do any activity that may cause you to hit your head. You will probably be able to return to work in less than 1 week.

What is normal pressure hydrocephalus? ›

Normal pressure hydrocephalus (NPH) is an abnormal buildup of cerebrospinal fluid (CSF) in the brain's ventricles, or cavities. It occurs if the normal flow of CSF throughout the brain and spinal cord is blocked in some way.

What is non communicating hydrocephalus? ›

Non-communicating hydrocephalus - also called obstructive hydrocephalus - occurs when the flow of CSF is blocked along one or more of the narrow passages connecting the ventricles.

How long can adults live with normal pressure hydrocephalus? ›

Conclusions: Clinical improvement of patients with NPH can be sustained for 5-7 years in some patients with NPH, even if shunt revision surgery is needed multiple times.

How does NPH affect walking? ›

Difficulty walking.

In many cases, people with NPH have trouble picking up their feet. Some describe it as feeling like their feet are stuck to the floor. This can lead to a shuffling walk and problems going up stairs and over curbs. It also increases your risk of falling.

Does normal pressure hydrocephalus make you tired? ›

Hydrocephalus can be the cause of headaches as well as some loss of both coordination and balance, seizures, and impaired vision. Another of the physical symptoms is also sleepiness, although many have difficulty falling and staying asleep due to headaches or pain.

Can you fly if you have a shunt? ›

Flying. Flying in a regular commercial jet is fine for most people with shunts. If you were told years ago not to fly, it's worth asking your neurosurgeon again as things have changed. Some people will have been told by their neurosurgeon not to fly, for specific reasons, so do check if this applies to you.

Does hydrocephalus affect memory? ›

The major cognitive impairment in patients with idiopathic normal pressure hydrocephalus (iNPH) is frontal lobe symptoms, such as psychomotor slowing and impairment of attention, working memory, verbal fluency and executive function.

Can you drive with a brain shunt? ›

Brain Shunt Recovery at Home

You are not allowed to drive a car. Your doctor will give you specific instructions about driving on discharge or when you follow-up in the office. You can ride as a passenger in a car as directed.

Does NPH run in families? ›

Normal pressure hydrocephalus (say: hi-drosef-uh-lus; or NPH for short) is a rare, but sometimes treatable, cause of dementia. It mainly affects people older than 60. It does not run in families. Sometimes it happens after a brain infection, such as meningitis.

Is normal pressure hydrocephalus a form of dementia? ›

Treatment. Normal pressure hydrocephalus is one of the few causes of dementia that can be controlled or reversed with treatment.

What does NPH gait look like? ›

Specific features of the gait disturbance in normal pressure hydrocephalus were a broad based gait pattern with outward rotated feet and a diminished height of the steps. After treatment in both diseases, the speed increased, due to an enlarged stride length, now presenting a lower variability.

What body systems are affected by hydrocephalus? ›

Hydrocephalus is the buildup of fluid in the cavities (ventricles) deep within the brain. The excess fluid increases the size of the ventricles and puts pressure on the brain. Cerebrospinal fluid normally flows through the ventricles and bathes the brain and spinal column.

Can hydrocephalus cause personality changes? ›

A 2018 study of neuropsychiatric abnormalities in 153 NPH patients was able to analyze the Cambridge Behavioral Inventory results of 41 patients and observed that 70.7% experienced abnormal behavior and 73.2% experienced changes in mood.

Can you live a normal life with hydrocephalus? ›

What is the prognosis? If left untreated, hydrocephalus can be fatal. Early diagnosis and successful treatment improve the chance for a good recovery. With the benefits of surgery, rehabilitative therapies, and educational interventions, many people with hydrocephalus live relatively normal lives.

Videos

1. Normal Pressure Hydrocephalus: What Your Doctors are Thinking Before and After the Shunt is Placed
(Hydrocephalus Association)
2. Shunt Surgery & Normal Pressure Hydrocephalus -- What to Expect -- DePuy Videos
(DePuy Synthes Companies)
3. NPH - Normal Pressure Hydrocephalus - 60 Minutes - Saved From Senility
(KTaylorTV1)
4. GNI Grand Rounds: Current Understanding of Normal Pressure Hydrocephalus
(Global Neurosciences Institute)
5. A PNI Minute | Normal Pressure Hydrocephalus
(Pacific Neuroscience Institute)
6. Normal Pressure Hydrocephalus | Patricia's Story
(Johns Hopkins Medicine)

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